Hospitals have a serious problem with their lack of executive diversity, American Hospital Association President and CEO Rich Umbdenstock acknowledged Monday.
"I know it's a problem, just looking out at the audience" of 1,300 executives attending AHA's 19th Annual Leadership Summit in San Diego this week, he said during an interview.
And they know they need to address racial and ethnic disparities in care and increase their language and cultural literacy, tailored to the communities they serve.
So the AHA took a bold step Monday to elevate the profile of disparities and diversity, to persuade member organizations to give the issues more focus. It called on all hospitals to take three steps to improve in a campaign they call Equity of Care.
First, the AHA wants all hospitals to begin collecting race, ethnicity, and language information on all patients, whether they enter hospitals through the emergency room or to a treatment floor. The AHA has helped to develop a National Quality Forum "best practice" computerized tool kit that allows hospital personnel an easy way to log this information in for each patient.
Second, there's a great need to increase cultural competency in the training of clinicians and support staff. "We want to make sure that all hospital personnel who have patient contact get cultural competency training," Umbdenstock said.
Third, the group called for increasing diversity in governance and management, in board members and in executive positions, to be more reflective of their patient communities.
"The third one, our people say is most challenging, but we have a lot of members who are great case studies, people who have morphed the composition of board and senior leadership to be more reflective. But we do know that our compositions do lag. They are generally white."
On the first call to action, Umbdenstock says, better ethnic, racial, and language data will enable each hospital to better understand how their treatment processes and procedures are applied to various groups and whether they show good comparative outcomes.
"Everybody complains that this data is not being collected now, not on a patient specific basis," he explained. "We don't have it to overlay with our own quality data, to know our own populations."
"How do you know that the patients within your walls are getting the same care, and if they're getting the same care, are they getting the same outcomes."
It may reveal, for example, that patients in different groups do need to be treated differently. "Maybe you find out that one population is the one that's coming back (being readmitted) more often, or that demographically one population is more vulnerable, or there's some sort of cultural issue at home. Who knows?"
What each hospital would learn from this, over time would be, for example, "your African American population subset has outcomes of X, versus the entire population of Y, and you'd see what might be the gap."
With more intense focus on these three problems, Umbdenstock was asked what he hopes the future holds after these three efforts get off the ground, say, three to five years down the road.
"I hope we can say that we're seeing a narrow gap in the actual care and outcomes for minority populations. We want to see that needle move in the right direction."
The AHA knows that it must improve minority representation in its leadership and cultural competency to improve care for all their patients. Soon, racial and ethnic minorities who now represent one-third of the U.S. population, will no longer be the minority. By 2042, they will represent the majority of patients throughout the country.
The effort is organized by John Bluford, AHA Chairman; Sister Carol Keehan, CEO of the Catholic Health Association; Tom Dolan, president and CEO of the American College of Healthcare Executives; Atul Grover of the Association of American Medical Colleges and Kevin Lofton, president and CEO of Catholic Health Initiatives.